Nurses' career choice and satisfaction with mental health transition-to-practice programs: A cross sectional study.

WHAT IS KNOWN ON THE SUBJECT?: There are significant issues recruiting nurses into mental health due to several reasons such as dilution of curriculum, and mental health being an unpopular career choice Transition programs provide nurses entering mental health with orientation, academic and clinical skills, and knowledge. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Transition programs need to be nuanced to specialty areas (e.g. community) to ensure nurses are given the support necessary to remain working in the field. Many nurses choose to work in mental health due to a lived or personal experience and as such strengthening wellbeing supports for transitioning nurses is an important role in retention. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Tailored transition programs can help strengthen mental health nurse role clarity, and support staff retention. Transition programs should be a segue to formal postgraduate studies in mental health nursing to strengthen professional practice and retention of nurses. ABSTRACT: INTRODUCTION: Globally, there are consistent issues recruiting staff into the mental health nursing workforce. In Australia, recent efforts to expand the workforce include recruitment of a wider range of nurses in addition to new graduates into mental health transition-to-practice programs. Understanding the career motivations of nurses entering the field is an important element of recruitment and retention. AIM: To describe nurses' satisfaction with their mental health transition program and identify factors influencing their choice of mental health as a career. METHODS: An online cross-sectional survey with questions on program satisfaction and career choice was responded to by n = 55 enrolled and registered nurses in a mental health transition program. RESULTS: Nurses reported overall high satisfaction with their program and identified increased time release for professional development and being supernumerary as necessary to support role development. Almost 25% of nurses reported personal experience of mental illness as an influence in choosing a mental health career. DISCUSSION: Mental health transition programs are important in recruitment and retention and need to be tailored to the needs of a wide range of nurses and include support for staff wellbeing. IMPLICATIONS FOR PRACTICE: Tailored transition programs can help strengthen role clarity, and support staff retention.

Well-being, turnover intention, and stigma attitudes of mental health transition-to-practice nurses: A cross-sectional study.

There is global recognition that mental health nursing can be stressful and have detrimental effects on nurses' well-being and retention. With substantial nursing shortages, there is an urgent need to attract and retain nurses to sustain this workforce and provide effective mental healthcare. Mental health transition programs provide vital recruitment pathways and support novice registered nurses, enrolled nurses and experienced registered generalist nurses moving into this field. There is little evidence, however, on the well-being, resilience, and retention of nurses transitioning into mental health. The primary aims for this cross-sectional study were to describe demographic characteristics, perceived stress, well-being, resilience, mental illness stigma attitudes, work satisfaction, and turnover intention of four nurse cohorts entering mental health transition programs: generalist registered nurses, graduate and post-graduate registered nurses, and enrolled nurses; to explore relationships between these variables; and explore differences between these four nurse cohorts. Findings (n = 87) included overall moderate perceived stress, moderate well-being and resilience, high work satisfaction, low stigma, and low turnover intention. Higher turnover intention was associated with lower age and work satisfaction, and higher perceived stress. Generalist RNs had significantly higher stress and stigmatizing attitudes than Enrolled Nurses. Secondary analysis of well-being scores identified 14 nurses with scores indicating depression, with significantly lower resilience and work satisfaction, and significantly higher stress than the rest of the sample. To help prevent attrition, it is vital that mental health services provide tailored well-being initiatives during transition and intervene early to provide support for nurses with mental distress.

Grace under pressure: Mental health nurses' stories of resilience in practice.

Mental health nurses experience both organizational and practice-related stressors in their work. Resilience is an interactive process of positive adaptation following stress and adversity. There is limited evidence on how personal resilience is applied to mental health nursing practice. The aim of this interpretive narrative study was to explore mental health nurses' stories of resilience in their practice for the purpose of gaining an understanding of resilience resources they draw on when dealing with challenging workplace situations. A storytelling approach was used in semistructured phone interviews with 12 mental health nurses who measured high on resilience (Workplace Resilience Inventory) and caring behaviours (Caring Behaviours Inventory). Within and across case narrative analysis produced stories of resilient practice within four themes: proactively managing the professional self; sustaining oneself through supportive relationships; engaging actively in practice, learning and self-care; and seeking positive solutions and outcomes. Nurses displayed poise in stressful situations and grace under pressure in demanding and emotionally challenging interactions, holding dignity and respect for self and others, with the aim of achieving positive outcomes for both. Resilient practice is the responsibility of organizations as well as individuals. To develop practice and support staff retention, we recommend organizations use tailored professional development to cultivate a growth mindset in new and experienced staff, develop organizational strategies to build positive team cultures, and prioritize strategies to reduce workplace stressors and strengthen staff psychological safety and well-being. The use of narrative techniques in reflective practice and clinical supervision may help build nurses' resilience and practice.

Interventions for Parental Anxiety in Preparation for Pediatric Surgery: A Narrative Review.

The preoperative experience can cause significant anxiety for both pediatric patients and their parents in the lead up to a surgical procedure. Pediatric anxiety in a preoperative setting has been shown to have significant negative downstream effects on the clinical outcomes of children and the healthcare system as a whole. Studies have found that preoperative parental anxiety has significant negative effects on children, regarding anxiety and emotional response. Therefore, interventions for parental preoperative anxiety are important to reduce the child's anxiety. This review provides a brief overview of a broad range of strategies used to alleviate parental anxiety in a preoperative setting. Preoperative education, play-based interventions, music therapy, the presence of parents at induction of anesthesia, and integrative preoperative preparation programs have all demonstrated some evidence for reducing parental preoperative anxiety. The ultimate goal of using interventions for parental preoperative anxiety is to equip healthcare systems to better support families and optimize the perioperative outcomes of children.

'Anyone can have a mental illness': A qualitative inquiry of pre-registration nursing students' experiences of traditional mental health clinical placements.

Nurses play a crucial role in mental healthcare provision. Like many countries, Australian nursing students are educated in comprehensive pre-registration programmes which include mental health clinical placements. Placements play a vital role in students' education, providing the opportunity to engage with consumers and develop mental health nursing knowledge and skills. There is limited knowledge of student perspectives on traditional placements in contemporary recovery-oriented mental health services. This interpretive qualitative inquiry aimed to explore nursing students' experience of traditional mental health clinical placement and how it influenced their practice and their understandings of recovery from mental illness. Data were collected from focus groups with n = 31 nursing students in a large metropolitan public mental health service. Thematic analysis resulted in three themes of experience: humanizing people with mental illness; learning about recovery; and shifting perspectives on mental health nursing. Through a positive placement experience where they felt supported and included by staff, students came to see consumers as people rather than diagnoses, developed greater understanding of mental health nursing work and were more likely to consider mental health nursing as a career choice. Peer-support workers were an important influence on students' understandings of recovery and have a key role to play in educating students on placement. Students need to be prepared and supported by university and clinical staff to deal with vicarious trauma that may occur on placement. Mental health placements play a crucial role in attracting students into the field, and it is imperative they remain part of comprehensive pre-registration education.

Development and Pilot Testing of a Context-Relevant Safe Anesthesia Checklist for Cesarean Delivery in East Africa.

BACKGROUND: Maternal mortality rate in developing countries is 20 times higher than in developed countries. Detailed reports surrounding maternal deaths have noted an association between substandard management during emergency events and death. In parallel with these findings, there is increasing evidence for cognitive aids as a means to prevent errors during perioperative crises. However, previously published findings are not directly applicable to cesarean delivery in low-income settings. Our hypothesis was that the use of obstetric anesthesia checklists in the management of high-fidelity simulated obstetrical emergency scenarios would improve adherence to best practice guidelines in low- and middle-income countries. METHODS: Accordingly, with input from East African health care professionals, we created a context-relevant obstetric anesthesia checklist for cesarean delivery. Second, clinical observations were performed to assess in a real-world setting. Third, a pilot testing of the cognitive aid was undertaken. RESULTS: Clinical observation data highlighted significant deficiencies in the management of obstetric emergencies. The use of the cesarean delivery checklist during simulations of peripartum hemorrhage and preeclampsia showed significant improvement in the percentage of completed actions (pretraining 23% ± 6% for preeclampsia and 22% ± 13% for peripartum hemorrhage, posttraining 75% ± 9% for preeclampsia, and 69% ± 9% for peripartum hemorrhage [P < .0001, both scenarios; data as mean ± standard deviation]). CONCLUSIONS: We developed, evaluated, and begun implementation of a context-relevant checklist for the management of obstetric crisis in low- and middle-income countries. We demonstrated not only the need for this tool in a real-world setting but also confirmed its potential efficacy through a pilot simulation study.

Spectroscopic differences in posterior insula in patients with chronic temporomandibular pain.

Background and aims Chronic pain including temporomandibular disorder (TMD) pain involves a complex interplay between peripheral and central sensitization, endogenous modulatory pathways, cortical processing and integration and numerous psychological, behavioral and social factors. The aim of this study was to compare spectroscopic patterns of N-Acetyl-aspartate (NAA), total creatine (tCr), choline (Cho), myo-inositol (MI), glutamate (Glu), and the combination of Glu and glutamine in the posterior insula in patients with chronic generalized or regional chronic TMD pain (gTMD and rTMD, respectively) compared to healthy individuals (HI) in relation to clinical findings of TMD pain. Methods Thirty-six female patients with chronic rTMD or gTMD with at least 3 months duration were included in the study. Ten healthy women were included as controls. All participants completed a questionnaire that comprised assessment of degrees of depression, anxiety, stress, catastrophizing, pain intensity, disability and locations. A clinical Diagnostic Criteria for Temporomandibular Disorders examination that comprised assessment of pain locations, headache, mouth opening capacity, pain on mandibular movement, pain on palpation and temporomandibular joint noises was performed. Pressure-pain threshold (PPT) over the masseter muscle and temporal summation to pressure stimuli were assessed with an algometer. Within a week all participants underwent non-contrast enhanced MRI on a 3T MR scanner assessing T1-w and T2-w fluid attenuation inversion recovery. A single-voxel 1H-MRS examination using point-resolved spectroscopy was performed. The metabolite concentrations of NAA, tCr, Cho, MI, Glu and Glx were analyzed with the LC model. Metabolite levels were calculated as absolute concentrations, normalized to the water signal. Metabolite concentrations were used for statistical analysis from the LC model if the Cramér-Rao bounds were less than 20%. In addition, the ratios NAA/tCr, Cho/tCr, Glu/tCr and MI/tCr were calculated. Results The results showed significantly higher tCr levels within the posterior insula in patients with rTMD or gTMD pain than in HI (p=0.029). Cho was negatively correlated to maximum mouth opening capacity with or without pain (rs=-0.42, n=28, p=0.031 and rs=-0.48, n=28, p=0.034, respectively) as well as pressure-pain threshold on the hand (rs=-0.41, n=28, p=0.031). Glu was positively correlated to temporal summation to painful mechanical stimuli (rs=0.42, n=26, p=0.034). Conclusions The present study found that increased concentrations of Cho and Glu in the posterior insular cortex is related to clinical characteristics of chronic TMD pain, including generalized pain. These findings provide new evidence about the critical involvement of the posterior insular cortex and the neurobiology underlying TMD pain in both regional and generalized manifestations. Implications The findings in this study have indirect implications for the diagnosis and management of TMD patients. That said, the findings provide new evidence about the critical involvement of the posterior insular cortex and the neurobiology underlying TMD pain in both regional and generalized manifestations. It is also a further step towards understanding and accepting chronic pain as a disorder in itself.

Clinical implementation of photon beam flatness measurements to verify beam quality.

This work describes the replacement of Tissue Phantom Ratio (TPR) measurements with beam profile flatness measurements to determine photon beam quality during routine quality assurance (QA) measurements. To achieve this, a relationship was derived between the existing TPR15/5 energy metric and beam flatness, to provide baseline values and clinically relevant tolerances. The beam quality was varied around two nominal beam energy values for four matched Elekta linear accelerators (linacs) by varying the bending magnet currents and reoptimizing the beam. For each adjusted beam quality the TPR15/5 was measured using an ionization chamber and Solid Water phantom. Two metrics of beam flatness were evaluated using two identical commercial ionization chamber arrays. A linear relationship was found between TPR15/5 and both metrics of flatness, for both nominal energies and on all linacs. Baseline diagonal flatness (FDN) values were measured to be 103.0% (ranging from 102.5% to 103.8%) for 6 MV and 102.7% (ranging from 102.6% to 102.8%) for 10 MV across all four linacs. Clinically acceptable tolerances of ± 2% for 6 MV, and ± 3% for 10 MV, were derived to equate to the current TPR15/5 clinical tolerance of ± 0.5%. Small variations in the baseline diagonal flatness values were observed between ionization chamber arrays; however, the rate of change of TPR15/5 with diagonal flatness was found to remain within experimental uncertainty. Measurements of beam flatness were shown to display an increased sensitivity to variations in the beam quality when compared to TPR measurements. This effect is amplified for higher nominal energy photons. The derivation of clinical baselines and associated tolerances has allowed this method to be incorporated into routine QA, streamlining the process whilst also increasing versatility. In addition, the effect of beam adjustment can be observed in real time, allowing increased practicality during corrective and preventive maintenance interventions.

Are fourth-year medical students as prepared to manage unstable patients as they are to manage stable patients?

PURPOSE: To evaluate the fourth-year medical student's assessment and management of an unstable patient. METHOD: The authors compared the performance of fourth-year medical students in a clinical performance examination (CPX) across a spectrum of simulated stable conditions as compared with a case of ST-elevation myocardial infarction (STEMI). All fourth-year medical students at the Medical University of South Carolina participated in an eight-station CPX. Student performance was graded as the percentage of correct steps performed according to checklists developed through a modified Delphi technique. Repeated analysis of variance was performed to compare performance on different stations. Data are reported as mean (standard deviation), and P < .05 was considered significant. RESULTS: A total of 143 fourth-year medical students participated in the study. The percentage of correct actions performed in the STEMI station was 47.8 (9.5), which was significantly lower than all other stations (P < .001). There was no difference in overall performance between any of the other stable encounters. Students performed significantly worse in the physical and management/treatment components of the STEMI station, as compared with history, differential diagnosis, labs/tests, and diagnosis. CONCLUSIONS: Fourth-year medical students were less prepared to manage a simulated STEMI case compared with a range of nonacute conditions. Given the prevalence of coronary artery disease and the necessity of interns to be equipped to handle emergent situations, this deficiency should be addressed in undergraduate medical curricula.

Simulation curriculum can improve medical student assessment and management of acute coronary syndrome during a clinical practice exam.

BACKGROUND: It has been noted that increased focus on learning acute care skills is needed in undergraduate medical curricula. This study investigated whether a simulation-based curriculum improved a senior medical student's ability to manage acute coronary syndrome as measured during a clinical performance examination (CPX). The authors hypothesized that simulation training would improve overall performance when compared with targeted didactics or historical controls. METHODS: All 4th-year medical students (n = 291) over 2 years at the authors' institution were included in this study. In the 3rd year of medical school, the "control" group received no intervention, the "didactic" group received a targeted didactic curriculum, and the "simulation" group participated in small group simulation training and the didactic curriculum. For intergroup comparison on the CPX, the authors calculated the percentage of correct actions completed by the student. Data are presented as mean ± standard deviation with significance defined as P < 0.05. RESULTS: There was a significant improvement in overall performance with simulation versus both didactics and control (P < 0.001). Performance on the physical examination component was significantly better in simulation versus both didactics and control, as was for diagnosis: simulation versus both didactics and control (P < 0.02 for all comparisons). CONCLUSIONS: Simulation training had a modest impact on overall CPX performance in the management of a simulated acute coronary syndrome. Additional studies are needed to evaluate how to further improve curricula regarding unstable patients.

The combination of non-selective NSAID 400 mg and paracetamol 1000 mg is more effective than each drug alone for treatment of acute pain. A systematic review.

The aim was to evaluate the evidence on outcomes of the combination of non-selective NSAID/ paracetamol compared to either drug alone, to relieve acute pain following oral surgery in adult patients. A systematic review of available literature was performed. The first step comprised searches in three electronic databases. Original studies written in English were searched. As a second step, the reference lists of included publications were searched for additional publications. Abstracts were retrieved if the title contained information on postoperative pain, NSAID, and paracetamol in combination with oral surgery. Two reviewers selected publications on the basis of predetermined inclusion criteria. Data were extracted using one protocol and the quality of each study was assessed using another protocol. The initial search in PubMed resulted in 138 abstracts and in the Cochrane library a further four. The search in the Web of Science resulted in no additional abstract. Five RCTs fulfilled the inclusion criteria. Pain relief from the combination of non-selective NSAID with paracetamol was significantly better than with paracetamol alone as well as with NSAID alone. Nausea, vomiting, headache, and dizziness were among the most common adverse events in all treatment groups. Most of the adverse events were of mild to moderate severity. Two studies reported no significant differences in adverse events between the treatment groups. According to one study the adverse events were significantly lower for the combination ibuprofen 400 mg/paracetamol 1000 mg compared to ibuprofen 400 mg alone. The need for rescue drugs in the different groups varied between the studies. Since the studies reported a significantly better postoperative pain relief with the combination of non-selective NSAIDs/paracetamol compared to each drug alone, this combination might be considered the treatment of choice, as long as side effects of NSAIDs are observed.

Land trust evaluation of progress toward conservation goals.

In the United States local land trusts preserve and conserve land to protect water quality and supply, farmlands, habitat for native plants and animals, areas of cultural or historical significance, and scenic views. We surveyed the 24 active, local land trusts in North Carolina (U.S.A.) to determine how they report progress toward attaining such conservation goals. Twenty-two land trusts responded to our survey. Of these, eight reported developing specific conservation goals for all of the properties they protect, five identified conservation targets on all properties, and two reported monitoring biological indicators on all of their protected properties. On the basis of these results, we believe most of the land trusts surveyed could not determine whether they were meeting conservation goals because most did not identify explicit, measurable goals and monitor progress toward them. Instead they reported success in terms of the amount of land protected and money raised. We think this is a lost opportunity for land trusts to build sound approaches to environmental management, engage the public, entice new donors, and attain funding for additional conservation activities. We propose conservation professionals help local land trusts adopt the Open Standards for the Practice of Conservation, a framework developed by a consortium of international conservation organizations, to develop conservation goals and measure whether the goals are achieved.